PEDBASE.org - The Pediatric Database - Detailed information of HAND-FOOT-AND-MOUTH DISEASE

HAND-FOOT-AND-MOUTH DISEASE

DEFINITION:

A viral infection of the skin and oral mucosa characterized by vesicular eruptions restricted to the hands and feet and in the mouth.

EPIDEMIOLOGY:

incidence: common
age of onset:
- any but usually in young children
risk factors:
- summer and fall in small epidemics

PATHOPHYSIOLOGY:

1. Background

first described in 1957
etiological agents
- major - coxsackievirus A16, A5, and A10
- minor - enterovirus 71
route of transmission
- ? direct person to person transmission
incubation period
- 4-6 days
clinical expression rate
- young children (100%)
- school-aged children (38%)
- adults (11%)

CLINICAL FEATURES:

1. Systemic Manifestations

low-grade fever
adenopathy

2. Cutaneous Manifestations

1. Hands and Feet

hands more commonly involved than the feet
dorsal surfaces more commonly involved than the palmar surfaces (often interdigital)
initially maculopapular lesions which form into grey-white vesicles on a normal or erythematous base
vesicles are from 3-7 mm in size and painless
a maculopapular rash commonly appears on the buttock but rarely goes on to form vesicles

2. Intraortal Lesions

tongue and buccal mucosa most frequently involved with the palate, gums, and lips less frequently involved
- vesicles may go on to ulcerate
vesicles are from 4-8 mm in size

3. Complications

1. Neurological Manifestations

aseptic meningitis
encephalitis
paralytic disease

INVESTIGATIONS:

1. Serum

CBC - leukocytosis

MANAGEMENT:

1. Supportive

tylenol 15 mg/kg po q4h for fever

2. Prognosis

self-limited and vesicles disappear after 1 week

Pediatric Database - HAND-FOOT-AND-MOUTH DISEASE

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